Outcomes of Hydroxyapatite Bone Cement for Craniofacial Reconstruction in 1983 Patients

Background: Hydroxyapatite bone cement (HABC) has evolved to have diverse applications in craniofacial reconstruction. This ranges from filling cranial defects to secondary contouring of residual defects after primary surgeries. This study aims to determine patient outcomes after reconstruction with HABCs.

Methods: A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. PubMed, Embase, Web of Science, and Cochrane Library databases were queried. The results were limited to English-language literature with extractable data on HABC for craniofacial reconstruction.

Results: A total of 1983 patients were included in the final analysis from 35 studies. HABCs were mostly used for large defect cranioplasty (21.5%), retrosigmoid (44.6%) and translabyrinthine cranioplasty (8.9%), and correction of residual craniofacial defects after congenital craniofacial surgeries (25%). The rates of cerebrospinal fluid (CSF) leak and infection/explantation were 0% and 7.5% [95% CI: 2.4-11.8] for large defect cranioplasty and 0.8% [0.03-2.07] and 1.5% [95% CI: 0.92-3.3] for retrosigmoid cranioplasty, respectively. The infection/explantation rate was 6.2% [95% CI: 2.6-18.7] for HABCs in the correction of residual craniofacial defects after congenital craniofacial surgeries. The total reoperation rates were 20.4% % [95% CI: 4.8-11.8] for large defect cranioplasty and 12% [95% CI: 3.3-15.3] for correction of residual defects after congenital craniofacial surgeries. Aesthetic satisfaction rates were 93.1% [95% CI: 90.3-98.8] for large defect cranioplasty, 99.4% [95% CI 97.2-99.9] for retrosigmoid cranioplasty, and 92.6% [95% CI: 83.3-95.8] for HABC use in the correction of residual craniofacial defects after congenital craniofacial surgeries.

Conclusion: HABC is versatile and associated with a high level of patient reported aesthetic satisfaction after cranioplasty and may have a comparably lower complication profile than those of most other alloplastic materials.